=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053961003
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAOMI CLIFTON-HERNANDEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2019
-----------------------------------------------------
Last Update Date | 07/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19272 STONE OAK PKWY STE 101
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-3372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-265-8851
-----------------------------------------------------
Fax | 210-265-8855
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4615 VILLA NAVA ST
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78233-6719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-748-4068
-----------------------------------------------------
Fax | 210-580-8255
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP143007
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------